Multiple sclerosis is an autoimmune chronic inflammatory disease characterized by selective destruction of myelin in the CNS neurons (including optic nerve). It was first described in the 19th century and remained elusive owing to the disease's unique relapsing and remitting course. The widespread and debilitating prevalence of multiple sclerosis (MS) has prompted the development of various treatment modalities for its effective management.The understanding of the pathogenesis of MS and the potential drug targets for its precise treatment has evolved significantly over the past decade. The experimental developments are also motivating and present a big change coming up in the next 5 years. Numerous disease-modifying therapies (DMTs) have revolutionized the management of MS: interferon (IFN) preparations, monoclonal antibodies—natalizumab and ocrelizumab, immunomodulatory agents—glatiramer acetate, sphingosine 1-phosphate receptor 1 (S1PR1) modulators (Siponimod) and teriflunomide. The traditional parenteral drugs are now available as oral formulations improving patient acceptability. Repurposing various agents used for related diseases may reinforce the drug reserve to manage MS and are under trials. Although at a nascent phase, strategies to enhance re-myelination by stimulating oligodendrocytes are fascinating and hold promise for better outcomes in patients with MS.

Assessment of the disease course by people with multiple sclerosis (pwMS) themselves is important for a better understanding of the complex disease, patient counseling and treatment decisions. This may also facilitate identifying the often-unnoticed transition from relapsing-remitting (RRMS) to secondary progressive multiple sclerosis (SPMS).Cognition is one of the most evaluated neurologic subjects with which the gut microbiome is supposed to be associated. Cognitive impairment is a prevalent finding in patients with multiple sclerosis (MS). Here, we are about to study the current evidence on the effect of gut microbiota on cognition and MS. Although no direct evidence is in hand, putting all indirect research together, one could think of the hypothetical benefit of brain-gut axis interventions (possibly diet changes, probiotic administration, microbiota transplant) to solve the drastic problem of cognitive impairment in MS. Hence, researchers are encouraged to scan this horizon in order to fill the knowledge gaps in the field.

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Mishita
Journal Co-ordinator
Journal of Autoimmune Disorders